In its annual study of drug costs, Express Scripts Holding Co. found that it lowered prescription drug spending for workers compensation payers by 7.6% in 2016, which accounts for a second-year decline in opioid prescribing, according to a report released Tuesday.

Prescriptions for opioids decreased 13.4 %, a decline St. Louis-based Express Scripts says is due to a combination of Express Scripts’ “clinical solutions, aggressive client management, and state and federal opioid regulatory trends,” according to the 11th edition of its Workers’ Compensation Drug Trend Report.

Dr. Brigette Nelson, Scottsdale, Arizona-based senior vice president of workers’ compensation clinical management at Express Scripts, told Business Insurance that more doctors are seeking alternatives to caring for patients in pain because the environment for opioid prescribing continues to shift.

The report also found that 2016, opioids remained the most expensive therapy class at $391.35 per user per year — with the average cost of a physician-dispensed medication at $219.25, compared with $110.16 for a pharmacy-dispensed medication in 2016. Still, 13 of the top 25 workers compensation medications were opioids in 2016, the report states.